Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003338815 |
---|---|
Provider Name | Diana Berenice Galvan |
First Address | Ontario, CA 91764-4887 |
Second Address | Ontario, CA 91764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 13/07/2017 |